Conventional cleaning and chemotherapeutic treatment of dental implants often produces unsatisfactory results. In dealing with long standing dental implants in patients, there is no reliable way to maintain a dental implant once it becomes symptomatic. Peri-implant mucositis and peri-implantitis, for example, are significant problems. Using conventional devices and methods, dentists often wrestle with these issues until the implant fails or abscesses. Then the implant is often trephined out causing trauma to adjacent tissue and requiring more complex reconstruction involving significantly more morbidity. Instrumenting the defect in order to achieve degranulation, debridement, and disinfection, which is meant for removal of tissue tags, biofilm, debris, calculus, residual cements etc., all harboring pathogens, has been a challenge.
Implant surface properties vary widely among all the permutations and combinations of implant coatings (e.g., carbon, bisphosphonates, bone stimulating factors, bioactive glass and bioactive ceramics, fluoride, hydroxyapatite, calcium phosphate, and titanium/titanium nitride) and their applications mechanisms (e.g., plasma spraying, hydro-coating, and nanoscale technology). To avoid damaging the implant surface and sparking, dentists often avoid using metal instruments against a metal implant. Plastic or polymer scaling instruments are marketed for this purpose, but fall short in their effectiveness against the sometimes tenacious material which must be removed from the site. Also, conventional instruments are often too large to fit the peri-implant defect. Use of air powder abrasive and laser treatment as implant surface cleaning methods is not wide enough to draw definitive conclusions. Some dentists use stainless steel or metal alloy bur devices, but such metal to metal contact leaves not only the coating, but also screws on the implant surface, vulnerable to different degrees of damage.
The state of the art in peri-implant debridement appears to be mechanical debridement using a plastic manual hand scaler. But the short comings of such plastic scalers have been documented. Other mechanical debridement methods include the use of titanium bristles devices in combination with a high speed dental hand piece (see, e.g., U.S. Pat. App. Pub. No. 2012/0129129 to Fehr) which has been suggested as being “kinder” to the implant surface. These devices, however, have not gained popularity for several potential reasons. First, the wear characteristics of titanium and its alloys of the devices against titanium implants are well known to create exponentially accelerated wear of the devices. This results in attrition and diffusion and subsequent failure of the titanium bristle, which can result in particles being lost into the defect or, more generally, into the oral cavity. Additionally, the heat generated by the metal to metal contact cannot easily be contained considering that a very small temperature increment in a biologic environment can lead to bone necrosis and damage to pulpal tissue of adjacent teeth. Keeping in mind that such defects intended for instrumentation are generally just a few cubic millimeters in volume, there appears to be no instrument which is soft enough to not injure the biologic surfaces and still effectively achieve debridement.
To address these issues, implant manufactures have suggested mechanical debridement coupled with chemotherapeutics treatment aiming to disinfect and condition the area. However considering the viscosity of chemotherapeutics such as, but not limited to antibiotics, antiseptics, disodium salts, etc. against surface porosity and tortuous screw or bone like configurations (having surfaces which counter gravity), no instrument is both strong enough to bear and hold the agent and delicate enough to deliver the chemotherapeutic into implant configurations particularly in deeper defects. The Fehr instrument, for example, is designed to deliver EDTA to the site for the purpose of tissue conditioning. But, its titanium bristles may not be optimal for delivering various viscosity chemotherapeutics into a tortuous space.